Improving dementia reviews

harro
image source: http://www.nhsconfed.org/

In Harrogate, people with dementia traditionally had three routine reviews a year: two at the Tees, Esk and Wear Valleys NHS Foundation Trust memory clinic, and one at their GP practice. This limited the number of appointments available at the memory clinic, and meant those who really needed specialist care had to wait longer for it.

Harrogate and Rural District Clinical Commissioning Group (CCG) and Tees, Esk and Wear Valleys NHS Foundation Trust worked with local GP practices to improve the system for routine reviews. Since 2014, such reviews have been shared between the trust and GPs. Those with dementia are now seen alternately by their GP and the memory clinic at six monthly intervals.

Read the full document here

Diagnostic test accuracy of informant-based tools to diagnose dementia in older hospital patients with delirium

Jackson, T.A. et al. Age Ageing. (2016) 45 (4): 505-511.

Background: delirium and dementia co-exist commonly in hospital. Older people with delirium have high rates of undiagnosed dementia, but delirium affects the use of cognitive testing in dementia diagnosis. Novel methods to detect dementia in delirium are needed. The purpose of the study was to investigate the diagnostic test accuracy of informant tools to detect dementia in hospitalised older people with delirium.

Methods: the presence of dementia on admission was assessed using the short form of the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE-SF) and Alzheimer’s Disease 8 (AD8) in people over 70 years old with delirium. Reference standard diagnosis was made using Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria at 3 months. The main outcome measures were the diagnostic test accuracy of the IQCODE-SF and the AD8 in diagnosing DSM-IV dementia.

Results: dementia prevalence at 3 months was 61%. The area under the receiver operating characteristic curve (AUROC) was 0.93 (P < 0.0005) for admission IQCODE-SF and 0.91 (P < 0.0005) for admission AD8. An IQCODE-SF test result of >3.82 on admission had a sensitivity of 0.91 (0.79–0.97) and specificity of 0.93 (0.76–0.99) for detecting dementia. An AD8 of >6 had a sensitivity of 0.83 (0.69–0.92) and specificity of 0.90 (0.72–0.97) for detecting dementia.

Conclusion: the IQCODE-SF and AD8 are sensitive and specific tools to detect prior dementia in older people with delirium. The routine use of either tool in practice could have important clinical impact, by improving the recognition and hence management of those with dementia.

Read the article here

Study addresses safety concerns for older adults with diagnosed/undiagnosed dementia

ScienceDaily. Published online: 23 June 2016

B0005919 The criminal mind
Image source: Rowena Dugdale – Wellcome Images // CC BY-NC-ND 4.0

Dementia currently affects some 5 million people in the U.S., and that number is expected to triple by 2050. Having dementia affects the way you think, act, and make decisions.

In a study published in the Journal of the American Geriatrics Society, researchers examined how often older adults who have diagnosed and undiagnosed dementia engage in potentially unsafe activities.

The researchers examined 7,609 Medicare beneficiaries aged 65 to more than 90-years-old. Based on various cognitive tests, the researchers determined that 1,038 of the people they observed had probable dementia. Of that group, 457 had been diagnosed with dementia and 581 had not been diagnosed with dementia.

Nearly 1,000 participants tested as having “possible” dementia and 5,575 did not have dementia. Of the older adults with probable dementia, the researchers learned that:

  • 23 percent were still driving
  • 31 percent prepared hot meals
  • 22 percent managed their own finances
  • 37 percent managed their own medications
  • 21 percent attended doctors’ appointments alone

Read the full commentary here

Read the original research abstract here

Big data to smart data in AD: Real-world examples of advanced modeling and simulation

Haas, M. et al. Alzheimer’s & Dementia. Published online: 18 June 2016

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Image source: Marina Caruso – Wellcome Images // CC BY-NC-ND 4.0

Many disease-modifying clinical development programs in Alzheimer’s disease (AD) have failed to date, and development of new and advanced preclinical models that generate actionable knowledge is desperately needed. This review reports on computer-based modeling and simulation approach as a powerful tool in AD research.

Statistical data-analysis techniques can identify associations between certain data and phenotypes, such as diagnosis or disease progression. Other approaches integrate domain expertise in a formalized mathematical way to understand how specific components of pathology integrate into complex brain networks. Private-public partnerships focused on data sharing, causal inference and pathway-based analysis, crowdsourcing, and mechanism-based quantitative systems modeling represent successful real-world modeling examples with substantial impact on CNS diseases.

Similar to other disease indications, successful real-world examples of advanced simulation can generate actionable support of drug discovery and development in AD, illustrating the value that can be generated for different stakeholders.

Read the full article here

Commissioning for Value packs for CCGs

NHS Rightcare has published the last four in its set of Commissioning for Value packs for CCGs to help them identify the best opportunities for improving value for their populations.

ccgright
Image source: http://www.england.nhs.uk

The focus packs are on Cancer and Tumours; Mental Health and Dementia; Maternity and Early Years; and Musculoskeletal, Trauma and Injuries.  The information contained in each pack is designed to support local discussions and inform a more in-depth analysis around common conditions and pathways.

NHS Rotherham CCG focus packs available here

Carers Week 6 – 12 June

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Image source: Kai Hendry – Flickr // CC BY 2.0

Carers Week is an annual campaign to raise awareness of caring by highlighting the challenges that carers face and recognise the contribution they make to families and communities throughout the UK.

The campaign encourages others to organise activities and events throughout the UK.

This year the campaign will be focusing on building Carer Friendly Communities: Communities which support carers to look after their family or friends well, while recognising that they are individuals with needs of their own.

Is beer good for the brain?

ScienceDaily. Published online: 1 June 2016

beer-1290633_960_720While most people will agree that excessive consumption of alcohol can have a detrimental effect on the brain, there is less agreement regarding the effects of light or moderate drinking. This includes concern and controversy surrounding the effects of drinking on the development of neurodegenerative diseases such as Alzheimer’s (AD). This study investigated the association between consumption of different alcoholic beverages — beer, wine, and spirits — and one of the neuropathological signs of Alzheimer’s disease, β-amyloid (Aβ) aggregation in the brain.

Researchers examined data from 125 males participating in the Helsinki sudden death autopsy series, who at the time of death were 35 to 70 years old. Consumption of alcohol, Aβ aggregation in the brain, and apolipoprotein E (APOE) genotype were assessed. Surviving relatives answered a questionnaire used to gather the drinking history of the deceased, and Aβ was observed by immunohistochemical staining of brain sections.

Read the full commentary here

Read the original research abstract here

Older peoples sensory experiences of the natural world

 Orr, N. et.al. How do older people describe their sensory experiences of the natural world? A systematic review of the qualitative evidence. BMC Geriatrics. Published: 1 June 2016

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Image source: Sandra – Flickr// CC BY-ND 2.0

Background

Despite the increased scholarly interest in the senses and sensory experiences, the topic of older people’s sensory engagement with nature is currently under researched. This paper reviews and synthesises qualitative research evidence about how older people, including those living with dementia, describe their sensory engagement with the natural world.

Methods

Ten databases were searched from 1990 to September 2014: MEDLINE (Ovid), MEDLINE-in-Process (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), GreenFILE (EBSCO), ProQuest Sociology, ASSIA (ProQuest), International Bibliography of the Social Sciences (ProQuest); HMIC (Ovid); Social Policy and Practice (Ovid). Forward and backward citation chasing of included articles was conducted; 20 organizations were contacted to identify unpublished reports. Screening was undertaken independently by two reviewers.

Results

Twenty seven studies were included. Thematic analysis revealed that descriptions of sensory experiences are encompassed within six themes: descriptions from ‘the window’; sensory descriptions that emphasise vision; descriptions of ‘being in nature’; descriptions of ‘doing in nature’; barriers to sensory engagement; and meanings of being and doing in nature.

Conclusions

Older people derive considerable pleasure and enjoyment from viewing nature, being and doing in nature which, in turn has a positive impact on their wellbeing and quality of life. Future research could usefully explore how sensory engagement with nature could be used to stimulate reminiscences of places and people, and evoke past sensory experiences to enrich everyday life and maintain a sense of self.

click here to access the paper

person-centred care and QOL

Mami Yasuda & Hisataka Sakakibara Care staff training based on person-centered care and dementia care mapping, and its effects on the quality of life of nursing home residents with dementia Aging & Mental Health Published online: 01 Jun 2016

Objectives: To assess the effects of care staff training based on person-centered care (PCC) and dementia care mapping (DCM) on the quality of life (QOL) of residents with dementia in a nursing home.

Methods: An intervention of staff training based on PCC and DCM was conducted with 40 care staff members at a geriatric nursing home. The effects of the staff training on the QOL of residents with dementia were evaluated by the DCM measurements of 40 residents with dementia three times at about one-month intervals (first, baseline; second, pre-intervention; third, post-intervention).

Results: The well-being and ill-being values (WIB values) of the residents with dementia measured by DCM were not different between the first and second rounds before the staff training (p = 0.211). Meanwhile, the WIB values increased from the first and second rounds to the third post-intervention round (p = 0.035 and p < 0.001, respectively); over 50% of the residents had better WIB values. The behavior category ‘interactions with others’ in DCM also demonstrated a significant increase in the third round compared to the first round (p = 0.041).

Conclusion: Staff training based on PCC and DCM could effectively improve the QOL of residents with dementia.

 

 

Workforce development to provide person-centered care

Person-centered care can be effectively implemented by well-trained CCAs in the community.

Abstract:

Objectives: Describe the development of a competent workforce committed to providing patient-centered care to persons with dementia and/or depression and their caregivers; to report on qualitative analyses of our workforce’s case reports about their experiences; and to present lessons learned about developing and implementing a collaborative care community-based model using our new workforce that we call care coordinator assistants (CCAs).

Method: Sixteen CCAs were recruited and trained in person-centered care, use of mobile office, electronic medical record system, community resources, and team member support. CCAs wrote case reports quarterly that were analyzed for patient-centered care themes.

Results: Qualitative analysis of 73 cases using NVivo software identified six patient-centered care themes: (1) patient familiarity/understanding; (2) patient interest/engagement encouraged; (3) flexibility and continuity of care; (4) caregiver support/engagement; (5) effective utilization/integration of training; and (6) teamwork. Most frequently reported themes were patient familiarity – 91.8% of case reports included reference to patient familiarity, 67.1% included references to teamwork and 61.6% of case reports included the theme flexibility/continuity of care. CCAs made a mean number of 15.7 (SD = 15.6) visits, with most visits for coordination of care services, followed by home visits and phone visits to over 1200 patients in 12 months.
Full reference: Mary Guerriero Austrom et. al. Workforce development to provide person-centered care Aging & Mental Health Volume 20, Issue 8, 2016.